Causes and when to see a doctor

Many conditions can cause pain in the sternum, including injuries, pneumonia, bronchitis, and costochondritis. Gastrointestinal problems, such as acid reflux, can cause pain behind the sternum.

People may believe that their sternum pain is a heart attack symptom. However, it is possible to differentiate the two.

In this article, learn about the causes of sternum pain and the differences between sternum pain and heart problems.

The sternum is a flat T-shaped bone that sits at the front of the chest and connects to the ribs with cartilage. It forms part of the rib cage, a series of bones that protects the heart and lungs from injuries.

People often refer to the sternum as the breastbone.

Sternum pain can result from problems with muscles and bones near the sternum, as well as the sternum itself.

Substernal pain is discomfort occurring behind or below the sternum. It often results from gastrointestinal conditions.

Some of the most common causes of sternum and substernal pain are:

• costochondritis
• sternum fracture
• sternoclavicular joint injury
• collarbone injuries
• muscular strain or bruise
• hernia
• acid reflux
• pleurisy
• bronchitis
• pneumonia

Costochondritis is inflammation of the cartilage between the sternum and ribs. The medical term for this area is the costochondral joint.

The symptoms of costochondritis include:

• sharp pain on the side of the sternum area
• pain that worsens with a deep breath or a cough
• discomfort in the ribs

Inflammation in the costochondral joint may occur due to injury, infection, or irritation. A person may experience costochondritis due to:

• impact trauma
• respiratory tract infections
• severe coughing
• physical strains

Learn more about costochondritis here.

Like fractures in other parts of the body, sternum fractures can cause a lot of pain. Sternum fractures usually occur as a direct result of trauma, such as a car accident or sports injury.

People who believe they may have a sternum fracture should seek immediate medical attention in case of additional damage to the heart and lungs.

Symptoms of a sternum fracture include:

• pain during inhaling or coughing
• swelling over the sternum
• difficulty breathing

Learn more about fractures here.

The sternoclavicular joint connects the top of the sternum to the collarbone. Injuries to this joint generally cause pain and discomfort at the top of the sternum in the upper chest area.

People experiencing sternum pain due to a sternoclavicular joint injury will often experience the following:

• mild pain or swelling in the upper chest area
• difficulty or pain when moving the shoulder
• popping or clicking around the joint

The collarbone connects to the top corners of the sternum by cartilage. Due to the direct connection between the two structures, injuries to the collarbone may cause pain in the sternum area.

Collarbone trauma

Impact and stress trauma can damage, or even fracture, a person’s collarbone. Collarbone trauma may affect its connection to the sternum and the surrounding musculature. This may mean a person feels pain either in or around their sternum.

Depending on the location of collarbone trauma, other symptoms may include:

• severe pain when raising the arm
• bruising or swelling in the upper chest area
• abnormal positioning or sagging of the shoulder
• clicking and grinding in the shoulder joint

A great many muscles connect to the sternum and ribs. Injuries or trauma can result in bruising these muscles, which may cause them to ache. Strenuous or repetitive movements can also cause strains in these muscles.

Learn more about muscle strains here.

Most hernias occur in the abdomen. However, a hiatal hernia can affect the chest area and cause substernal pain.

A hiatal hernia occurs when the stomach moves past the diaphragm and into the chest. Symptoms of a hiatal hernia include:

• frequent burping
• heartburn
• vomiting blood
• a feeling of fullness
• trouble swallowing

People with substernal pain and symptoms of a hiatal hernia should see a doctor for prompt treatment.

Learn more about hernias here.

Acid reflux happens when stomach acid wears away the lining of the windpipe (esophagus). This happens primarily in people with gastroesophageal reflux disease (GERD).

Acid reflux may cause substernal pain and discomfort in the chest.

Pain in this region can also result from inflammation or a spasm of the windpipe. People with GERD should talk with their doctor about preventing further damage to this area.

Learn the difference between heartburn, acid reflux, and GERD here.

Pleura are sheets of tissue between the lungs and ribcage. Inflammation to these tissues is pleurisy.

Pleurisy can cause a sharp, stabbing pain at the site of irritation, which may worsen if a person breathes deeply, coughs, or wheezes.

If inflammation occurs toward the upper middle chest, pleurisy may cause substernal pain.

Learn more about pleurisy here.

Bronchitis is the inflammation of the primary airways of the lungs. The condition can cause:

• chest pain
• severe coughing spells
• shortness of breath
• wheezing

Inflammation of the primary airways may cause substernal pain.

Learn more about bronchitis here.

Pneumonia is a common lung infection that causes air sacs in the lungs to inflame and fill with fluid. The medical term for these air sacs is alveoli.

Pneumonia can cause sharp chest pains, which a person may feel behind their sternum.

Other symptoms of pneumonia include.

• severe coughing
• shortness of breath
• fever
• sweating
• nausea and vomiting
• loss of appetite
• confusion

Infectious bacteria, viruses and fungi can cause pneumonia.

Learn more about pneumonia here.

Symptoms of sternum pain vary depending on the cause. The most common symptom is discomfort and pain in the center of the chest, which is the location of the sternum.

Other associated symptoms may include:

• pain or discomfort in the ribs
• pain that worsens during deep breathing or coughing
• mild, aching pain in the upper chest
• swelling in the upper chest
• stiffness in the shoulder joints
• severe pain when raising the arms
• signs of collarbone trauma, such as bruising or swelling
• difficulty breathing
• grinding or popping sensation in joints near the sternum
• frequent belching
• heartburn
• feeling too full
• throwing up blood

People experiencing chest pain may worry they are having a heart attack. However, sternum pain differs from heart attack pain.

People who are having a heart attack experience specific signs before the heart attack itself, whereas most sternum pain starts suddenly.

A heart attack often occurs with the following symptoms:

• pressure, squeezing, or fullness in the center of the chest
• sweating
• nausea
• shortness of breath
• lightheadedness

However, anyone who thinks they are having a heart attack should seek immediate medical attention.

While sternum pain is not usually serious, there are some causes of sternum pain that require immediate medical attention.

A person should seek emergency medical attention if the pain:

• started as a result of direct trauma
• is accompanied by heart attack symptoms
• is persistent and does not improve over time
• is accompanied by intense vomiting or vomiting blood

A person should also speak to a doctor if the pain in their sternum gets worse or does not improve over time.

Physical trauma, costochondritis, and muscle strains are common causes of sternum pain.

Conditions such as pneumonia, pleurisy and GERD can also cause pain in nearby tissue that people may mistake for sternum pain.

Read the article in Spanish.

Sternal Injury | Rib Injury Clinic

A less common chest wall injury, it is usually caused by a direct blow, associated with an acceleration-deceleration injury or from a fall onto the front of the chest. The Sternum or breastbone is a strong bone and in otherwise fit and healthily patients’ significant injuries to the sternum usually suggest a fairly severe injury or blow. However, in frail patients particularly with associated osteopenia (weakness of bones) even an apparent minor injury can cause a sternal fracture.

Anatomy of the sternum. The sternum is made up of three parts (blue arrows) with two junctions (grey arrows)

Symptoms

Patients with a sternal or breastbone injury typically experience a sudden onset of chest pain at the time of injury. Pain is often sharp and intense and may increase during deep breathing, coughing, laughing or sneezing. Patients may also experience an ache in the front of the chest that is particularly prominent at night or first thing in the morning (particularly in the first few days following injury). Pain may increase when lying down in certain positions (such as face down or on your side) and on firmly touching the sternum at the site of injury. Swelling and / or bruising may also be evident. In severe sternal fractures with bony displacement, an obvious deformity may be present. Patients with this condition may also experience pain with certain movements of the upper back and chest (such as twisting, bending forwards or sideways, or arching backwards) and with certain movements of the upper limb (such as pushing, pulling, heavy lifting or with overhead activities).

Diagnosis

Sternal x-ray from the side showing significant sternal fracture.

As with rib injuries the diagnosis of a sternal injury is what doctors call a clinical one, that is taking a precise history of the injury coupled with a careful physical examination with a doctor familiar with chest wall injuries. Examination may demonstrate swelling, tenderness, occasionally crepitus (crunchy feeling under the skin) and if the sternum is badly broken a step. There is no specific blood test unless an associated chest infection or other internal complication is suspected. Radiological assessment with chest x-ray is not helpful as its very insensitive at picking up sternal injuries but may be helpful in identifying other associated problems such as fluid in the chest or a collapsed lung. More useful is a specific type of x-ray called a lateral sternal view.

If the injury is subtle occasionally a chest wall ultrasound may demonstrate a sternal fracture and associated bruising (haematoma) as well as identifying internal problems such as fluid around the heart (tamponade). The most sensitive radiological investigation is a Chest CT scan. This allows the severity of the sternal injury to be clearly seen as well as identifying any other chest related injuries such as haematoma behind the breastbone, fluid around the heart, lung bruising or contusions and other associated injuries.

Video of a Chest CT scan taken from the side (sagittal) demonstrating a displaced fracture through the body of the sternum.

Severity

Sternal injuries vary significantly from a minor injury with associated pain, tenderness and bruising to severe sternal fracture. The type of injury and what happened is often the most useful guide to severity of sternal injury. One specific type of sternal injury is an acceleration-deceleration type of car accident in a seat-belted occupant either directly from a direct blow to the sternum or indirectly.

As with the classification of rib fractures, sternal fractures are based on the appearance on Chest CT scan. They are described typically as:

Simple: Usually a single fracture either partially or completely through the sternum, which is not displaced (dislodged) or angulated.

Chest CT showing an un-displaced sternal fracture albeit in two places (blue ring)

Complex: Usually single occasionally multiple and displaced where the broken ends are misaligned or overlapping with an associated step (lump) on the front of the chest.

Chest CT showing a displaced sternal fracture. The fracture is through the Manubriosternal junction and area of nature weakness of the sternum.

Complications

Pain: Immediate (acute) and can be severe over the area and is sore to touch and worse on certain movements. In most the pain will settle, however occasionally it can persist and become chronic causing significant issues. The main reason for this is failure to manage appropriately after the initial injury (with painkillers, rest, restrictions of activity and tailored return to normal activities).

Sternal fractures do generally heal even if displaced but the patient may be left with a permanent lump and tenderness.

Deformity: Occasionally if the sternum is badly displaced a tender lump can develop over the fracture site.

Breathlessness: Shortness of breath acutely is usually caused by the chest wall pain not allowing deep breaths to be taken, occasionally it can be associated with the lung collapsing after the injury; a build-up of fluid in the chest cavity (effusion) or even a developing chest infection (pneumonia). Chronically, on-going breathlessness can be due to chronic pain but also occasionally to complications of retained blood or fluid in the chest cavity which can trap the lung.

Internal injuries: Very rarely, if the sternal injury is severe internal injuries can lead to sinister symptoms of severe breathlessness and even collapse due to blood building up around the heart (tamponade) or bruising (contusions) of the heart itself. Diagnosis requires an ultrasound scan of the heart or chest CT scan.

Xiphersternal injury: Pain at the bottom of the sternum in the area of the ‘solar plexus’ can occur following even minor injuries and may be caused by an injury to the xiphersternal junction or the xiphersternum itself. The xiphersternum is actually made of cartilage and is susceptible to injury and inflammation leading to long-term pain and discomfort. For more information see Complex chest wall injuries.

Treatment

Sternal injuries can usually be treated conservatively involving rest, restrictions of activities and painkillers, or occasionally through some form of intervention including targeted physical therapy or surgical options such Open Reduction Internal Fixation. See Treatments.

Why there are pains in the chest and chest

Enroll

August 24, 2022

read 5 minutes

“If we are discussing chest pain, then at a young age it is most often due to problems with the spine or intercostal muscles. Such pain is characterized by an increase in a certain posture or position of the body (for example, when bending to the side), there may be an increase in inhalation or exhalation, ”says Dr. Lummer.

As a rule, chest pain resolves on its own and does not require a serious examination.

Another option is pain behind the sternum, in the middle of the chest. Such pain may indicate a problem with the heart. A feature of heart pain is a compressive character. In addition, this pain often radiates to the left shoulder, left arm, left shoulder blade. If such pain occurs, you should immediately consult a doctor to exclude angina pectoris and myocardial infarction.

“Pain in the breast can also indicate a wide variety of different problems, from minimal to quite serious. Periodic discomfort associated with the menstrual cycle is quite common and does not indicate any serious pathology. As a rule, after pregnancy and childbirth, this disappears. But twitching pains, especially in combination with fever, reddening of the skin of the gland and a palpable volumetric formation, signal a serious inflammation – mastitis, ”explains Kirill Borisovich.

Moreover, mastitis can be both in nursing mothers and in women outside the period of breastfeeding. This is a reason to immediately consult a doctor. In addition, pain in the mammary gland can be caused by a disease such as fibrocystic mastopathy. This is a dyshormonal disease and, unfortunately, one cannot cope with it without qualified medical assistance.

“And, finally, the most frequent question, does pain in the mammary gland speak of a malignant formation? Unfortunately, this category of diseases is in no way characterized by pain, otherwise they would be much better detected, ”explains Dr. Lummer.

Therefore, it is correct for all women over 25 years old to have an ultrasound of the mammary glands once a year.

Ultrasound specialist
Surgeon

Source Rambler Doctor

Related Articles

October 18, 2021

If nodules are found on thyroid ultrasound, what should you do?

It is very important to find a qualified specialist for the description of ultrasound, as much of the description depends on who does it. The doctor will evaluate the node (or several) according to the TIRADS classification from 1 to 5, where the number is a certain degree of suspicion for malignancy.

Read article

05 April 2021

Female infertility: diagnosis and treatment

Up to a quarter of Russian marriages are infertile. We have already written about the problems of male fertility before, now let’s talk about women’s. We understand what infertility is, how it is diagnosed and treated.

Read article

November 14, 2018

International Federation of Obstetricians and Gynecologists (FIGO) Practice Guidelines for the Prevention of Preterm Birth

Let’s talk to the candidate of medical sciences, obstetrician-gynecologist of GMS Clinic Serine Ghazaryan.

Read article

Other articles by this author

November 14, 2018

How to prepare for an ultrasound?

Ultrasound is the most popular non-invasive diagnostic method. The research is based on the ability of ultrasound to reflect differently from objects with different density. We tell you how to properly prepare for the procedure and why it is so important.

Read
article

Why does it hurt in the chest? Signs and symptoms of angina pectoris

Ischemic heart disease

December 23, 2022
Author: medical adviser of Servier JSC, candidate of medical sciences, Anufrieva Elena Nikolaevna

Chest pain is an alarming symptom, but how to understand what caused it and is it necessary to urgently seek medical help? In such a situation, doctors first of all pay attention to the heart and try to find out as soon as possible whether the pain is associated with coronary heart disease and its frequent manifestation – angina pectoris.

What is IBS and why does it occur?

IHD (ischemic heart disease) occurs due to a violation of blood flow in the coronary arteries: the vessels that deliver blood to the heart muscle – the myocardium, the result of IHD is damage to this muscle.

The risk factors for developing coronary artery disease are well known, the main ones are:

• 1

  increase in the level of cholesterol and its fractions – “good” and “bad” cholesterol;

• 2

  high blood pressure;

• 3

  diabetes mellitus;

• 4

  smoking;

• 5

  low physical activity.

The term IHD itself includes acute transient conditions that occur suddenly and just as quickly pass – unstable angina, myocardial infarction, and also includes chronic conditions – stable angina, vasospastic angina.

In this article, we told in simple terms what happens in the body during coronary artery disease.

Angina pectoris as a manifestation of coronary artery disease

Angina pectoris or “angina pectoris” was first described in the 18th century and is now well understood and treatable.

Stable angina is caused by myocardial ischemia, a condition in which atherosclerotic plaques and narrowing of the coronary arteries cause a lack of oxygen to the heart muscle. Spasms of the coronary vessels are the cause of vasospastic angina.

Myocardial ischemia

Stable angina pectoris not detected and observed by a doctor in time can lead to the development of acute coronary syndromes – myocardial infarction and unstable angina pectoris, which will require coronary interventions, that is, emergency heart operations.

Learn more about the causes and types of angina, as well as the most dangerous manifestations of the disease. Watch the video and find out why it is so important to get an examination and treatment as soon as possible.

Typical manifestations (symptoms) of angina pectoris in men and women

If chest pain is suspected of being related to a heart problem, a few questions should be answered about the nature of the attack, the location of the pain, and the situations in which it comes and goes ¹ .

• 1. Where does the pain appear?

Typical angina is pain behind the sternum, in which the person unconsciously clenches his hand into a fist in front of the sternum. In more rare cases, pain occurs in the left side of the chest, while it shifts to the left arm, left shoulder blade and shoulder or lower jaw.

• 2. How would you describe the nature of the pain?

In angina pectoris, pain is most often described as pressure or squeezing. Sometimes, instead of a typical pain attack, a person is disturbed by such symptoms of angina pectoris as shortness of breath, a feeling of heaviness or burning in the chest.

• 3. How long does the pain last?

Usually angina attacks last 2 to 5 minutes, sometimes they last longer, but generally do not exceed 20 minutes.

• 4. When does pain usually occur?

Typically, pain attacks occur during, but never after, physical activity: for example, when carrying heavy loads, when walking, when a person tries to walk faster, or when climbing stairs. In some cases, an angina attack develops against a background of stress, emotional stress, or due to a sharp increase in blood pressure.

Provoking factors can be a rich meal, low or, conversely, very high air temperature – especially when it changes abruptly, for example, when going outside in winter or when visiting a sauna.

• 5. When does the pain stop?

Pain stops quickly with 1-2 short-acting nitrate tablets sublingually; 1.5–2 minutes after spraying a nitroglycerin spray on the oral mucosa, as well as with a decrease or cessation of physical or emotional stress, especially after resting in a sitting position.

If the pain meets at least four of the above characteristics, it is very likely to be angina pectoris ² .

When is a doctor needed?

It is far from always possible to understand what caused it only from the description of a painful attack. Angina pectoris may masquerade as an exacerbation of cholecystitis or gastric ulcer. On the other hand, pain from herniated discs, osteochondrosis and pinched vertebral nerves is not only very similar to angina pectoris, but can also provoke its attack. Therefore, if you have any doubts, incomprehensible or disturbing symptoms, the most correct decision would be to consult a doctor.

Here are the top 7 reasons to see a doctor:

• 1

  pain occurs now on the right, now on the left of the sternum;

• 2

  pain can be described as pinpoint;

• 3

  pain lasts more than 30 minutes;

• 4

  pain not related to exercise but dependent on movement or breathing;

• 5

  pain most often comes on at night or in the morning, or on exposure to cold;

• 6

  pain occurs at rest, poorly relieved by short-acting nitrate;

• 7

  attacks of pain are becoming more frequent.

All of the above may be a manifestation of a special vasospastic (Prinzmetal’s angina) or microvascular form of angina, as well as a sign that the attack was caused by causes not related to disorders in the heart ¹ . Only a cardiologist can clarify the situation, diagnose the disease and understand the cause of seizures.

In some cases, not just a doctor’s consultation, but emergency medical care is required if chest pain occurs against the background of a life-threatening condition – myocardial infarction, pulmonary embolism, aortic dissection.

• severe pain not relieved by short-acting nitrate;

• increasing pain in response to exercise;

• shortness of breath, rapid breathing;

• fainting, impaired consciousness;

• nausea, vomiting, profuse sweating;

• pallor and blueness of the skin;

• drop in blood pressure, rapid pulse.

If chest discomfort or pain is accompanied by any of the symptoms listed, call an ambulance immediately.

Non-heart causes

Angina pectoris is not the only cause of chest pain, there are other diseases that are characterized by pain. But the clinical manifestation of non-cardiac pain, as a rule, differs in its characteristics from the classic symptoms of typical angina and pain in other cardiac pathologies. Let’s look at the causes and characteristics of non-heart pain. ¹

Diseases of the digestive system as a cause of non-cardiac pain

Causes of non-cardiac pain:

• 1

  Diseases of muscles and joints: osteochondrosis, herniated disc, myositis.

• 2

  Diseases of the lungs and respiratory tract: pneumonia, pleurisy, bronchitis.

• 3

  Diseases of the digestive system: stomach ulcer, esophagitis, gastroesophageal reflux disease.

• 4

  Diseases of peripheral nerves: neuralgia, radicular syndrome.

Characteristics of non-cardiac pain:

• While angina is characterized by chest pain, non-cardiac pain is more likely to occur on the right or left side of the chest. Remember that it is not always possible to determine the exact cause of pain without additional examination!

• Non-cardiac pain can most often be described as dull, aching, or sharp (stabbing, cutting), while an attack of angina is usually accompanied by pressure or squeezing pain.

• The duration of non-cardiac pain can vary from a few seconds to several hours or days, while an angina attack lasts from 2 to 5-10 minutes.

• Occurs when moving, changing body position, taking deep breaths, or immediately after eating.

• Disappears after resting in the supine position or in a certain position, when taking painkillers and anti-inflammatory drugs.

If the attacks of pain are repeated again and again, it is better not to risk it and seek the advice of a doctor. In the arsenal of a specialist there are modern methods for diagnosing coronary artery disease, which

will allow you to quickly make the correct diagnosis, confirm or exclude coronary heart disease and prescribe the necessary drug therapy.

Attentive attitude to their condition, timely access to a doctor and careful adherence to recommendations allow patients with coronary artery disease to reduce the frequency of angina attacks, improve quality of life and delay the risk of myocardial infarction for a long time.